Provider Demographics
NPI: | 1801844857 |
---|---|
Name: | JAMES N. CLARK, D.D.S. INC. |
Entity Type: | Organization |
Organization Name: | JAMES N. CLARK, D.D.S. INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | NEWTON |
Authorized Official - Last Name: | CLARK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 661-325-5751 |
Mailing Address - Street 1: | 1805 28TH STREET, SUITE 101 |
Mailing Address - Street 2: | |
Mailing Address - City: | BAKERSFIELD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93301 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 661-325-5751 |
Mailing Address - Fax: | 661-327-2735 |
Practice Address - Street 1: | 1805 28TH ST |
Practice Address - Street 2: | |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93301-1903 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-325-5751 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2007-11-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 30599 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |